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This is VAERS ID 1086871

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1086871
VAERS Form:2
Age:
Sex:Female
Location:Wisconsin
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Abortion spontaneous, Urine analysis, Ultrasound abdomen, Blood test, Human chorionic gonadotropin, Exposure during pregnancy, Sexually transmitted disease test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRENATAL VITAMINS [MINERALS NOS;VITAMINS NOS]; LEXAPRO
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Cosmetic allergy (an allergy to an unknown beauty product); Endometriosis; Environmental allergy (environmental allergies); Kidney stone; Paroxysmal supraventricular tachycardia
Allergies:
Diagnostic Lab Data: Test Date: 20210222; Test Name: Blood Test; Result Unstructured Data: Normal test results; Test Date: 20210222; Test Name: HCG; Result Unstructured Data: 21297 (expected to be); Test Date: 20210222; Test Name: HIV/ Chlamydia /gonorrhea; Test Result: Negative ; Result Unstructured Data: HIV/ Chlamydia /gonorrhea; Test Date: 20210222; Test Name: Ultrasound; Result Unstructured Data: no fetal heart beat; Test Date: 20210222; Test Name: Urine; Result Unstructured Data: Tested normal/negative
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Miscarriage; Vaccine exposure during pregnancy; A spontaneous report was received from a consumer who was also a 41-year old, female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event miscarriage/ abortion spontaneous and vaccine exposure during pregnancy. The patient''s medical history included environmental allergies and an allergy to an unknown beauty product, kidney stone, endometriosis, anxiety, and paroxysmal supraventricular tachycardia. Products known to have been used by the patient, within two weeks prior to the event, included pre-natal vitamins and escitalopram oxalate. The patient received their first of two planned doses of mRNA-1273 (Batch number: 042L20A) intramuscularly on 14 Jan 2021. On 12 Feb 2021, the patient received their second of two planned doses of mRNA-1273 (Batch number: 012M20A) intramuscularly for prophylaxis of COVID-19 infection. On 21 Jan 2020, the patient had a positive pregnancy test. The first day of the patient''s last menstrual period was on 24 Dec 2020. The estimated date of conception was not provided. The due date was estimated as 30 Sep 2021. On 22 Feb 2021, the patient had a miscarriage. There was no fetal heartbeat on the ultrasound. On 24 Feb 2021, the patient underwent a procedure to complete the miscarriage. The patient received both scheduled doses of mRNA-1273; therefore, action taken with the drug in response to the event is not applicable. The outcome of the events was considered recovered.; Reporter''s Comments: This is a case of product exposure during pregnancy with an Adverse event of Spontaneous abortion for this 41-year-old female. Very limited information regarding this event has been provided at this time. Further information has been requested.


Changed on 5/7/2021

VAERS ID: 1086871 Before After
VAERS Form:2
Age:
Sex:Female
Location:Wisconsin
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Abortion spontaneous, Urine analysis, Ultrasound abdomen, Blood test, Human chorionic gonadotropin, Exposure during pregnancy, Sexually transmitted disease test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRENATAL VITAMINS [MINERALS NOS;VITAMINS NOS]; LEXAPRO
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Cosmetic allergy (an allergy to an unknown beauty product); Endometriosis; Environmental allergy (environmental allergies); Kidney stone; Paroxysmal supraventricular tachycardia
Allergies:
Diagnostic Lab Data: Test Date: 20210222; Test Name: Blood Test; Result Unstructured Data: Normal test results; Test Date: 20210222; Test Name: HCG; Result Unstructured Data: 21297 (expected to be); Test Date: 20210222; Test Name: HIV/ Chlamydia /gonorrhea; Test Result: Negative ; Result Unstructured Data: HIV/ Chlamydia /gonorrhea; Test Date: 20210222; Test Name: Ultrasound; Result Unstructured Data: no fetal heart beat; Test Date: 20210222; Test Name: Urine; Result Unstructured Data: Tested normal/negative
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Miscarriage; Vaccine exposure during pregnancy; A spontaneous report was received from a consumer who was also a 41-year old, female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event miscarriage/ abortion spontaneous and vaccine exposure during pregnancy. The patient''s medical history included environmental allergies and an allergy to an unknown beauty product, kidney stone, endometriosis, anxiety, and paroxysmal supraventricular tachycardia. Products known to have been used by the patient, within two weeks prior to the event, included pre-natal vitamins and escitalopram oxalate. The patient received their first of two planned doses of mRNA-1273 (Batch number: 042L20A) intramuscularly on 14 Jan 2021. On 12 Feb 2021, the patient received their second of two planned doses of mRNA-1273 (Batch number: 012M20A) intramuscularly for prophylaxis of COVID-19 infection. On 21 Jan 2020, the patient had a positive pregnancy test. The first day of the patient''s last menstrual period was on 24 Dec 2020. The estimated date of conception was not provided. The due date was estimated as 30 Sep 2021. On 22 Feb 2021, the patient had a miscarriage. There was no fetal heartbeat on the ultrasound. On 24 Feb 2021, the patient underwent a procedure to complete the miscarriage. The patient received both scheduled doses of mRNA-1273; therefore, action taken with the drug in response to the event is not applicable. The outcome of the events was considered recovered.; Reporter''s Comments: This is a case of product exposure during pregnancy with an Adverse event of Spontaneous abortion for this 41-year-old female. Very limited information regarding this event has been provided at this time. Further information has been requested.


Changed on 5/14/2021

VAERS ID: 1086871 Before After
VAERS Form:2
Age:
Sex:Female
Location:Wisconsin
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Abortion spontaneous, Urine analysis, Ultrasound abdomen, Blood test, Human chorionic gonadotropin, Exposure during pregnancy, Sexually transmitted disease test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRENATAL VITAMINS [MINERALS NOS;VITAMINS NOS]; LEXAPRO
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Cosmetic allergy (an allergy to an unknown beauty product); Endometriosis; Environmental allergy (environmental allergies); Kidney stone; Paroxysmal supraventricular tachycardia
Allergies:
Diagnostic Lab Data: Test Date: 20210222; Test Name: Blood Test; Result Unstructured Data: Normal test results; Test Date: 20210222; Test Name: HCG; Result Unstructured Data: 21297 (expected to be); Test Date: 20210222; Test Name: HIV/ Chlamydia /gonorrhea; Test Result: Negative ; Result Unstructured Data: HIV/ Chlamydia /gonorrhea; Test Date: 20210222; Test Name: Ultrasound; Result Unstructured Data: no fetal heart beat; Test Date: 20210222; Test Name: Urine; Result Unstructured Data: Tested normal/negative
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Miscarriage; Vaccine exposure during pregnancy; A spontaneous report was received from a consumer who was also a 41-year old, female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) resulting in the event miscarriage/ abortion spontaneous and vaccine exposure during pregnancy. The patient''s medical history included environmental allergies and an allergy to an unknown beauty product, kidney stone, endometriosis, anxiety, and paroxysmal supraventricular tachycardia. Products known to have been used by the patient, within two weeks prior to the event, included pre-natal vitamins and escitalopram oxalate. The patient received their first of two planned doses of mRNA-1273 (Batch number: 042L20A) intramuscularly on 14 Jan 2021. On 12 Feb 2021, the patient received their second of two planned doses of mRNA-1273 (Batch number: 012M20A) intramuscularly for prophylaxis of COVID-19 infection. On 21 Jan 2020, the patient had a positive pregnancy test. The first day of the patient''s last menstrual period was on 24 Dec 2020. The estimated date of conception was not provided. The due date was estimated as 30 Sep 2021. On 22 Feb 2021, the patient had a miscarriage. There was no fetal heartbeat on the ultrasound. On 24 Feb 2021, the patient underwent a procedure to complete the miscarriage. The patient received both scheduled doses of mRNA-1273; therefore, action taken with the drug in response to the event is not applicable. The outcome of the events was considered recovered.; Reporter''s Comments: This is a case of product exposure during pregnancy with an Adverse event of Spontaneous abortion for this 41-year-old female. Very limited information regarding this event has been provided at this time. Further information has been requested.

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